<p>The aim of this study was to examine how some Swedish school counsellor’s describe their school social work and how they look at its content. Further more the aim is to look at what restraining and promoting factors the school counsellor’s experience in their working situation. The approach of the study is qualitative and interviews have been made with five school counsellors. The results show that school counsellors have a variety of different working-areas, which consist of supporting and consulting pupils, parents and teachers through dialogue. Another assignment is to work preventive with groups and classes. Other scientists have found similar results as the ones in this study. About restraining and promoting factors in their work, the school counsellors expressed, for example, time and resources as restraining factors and as promoting factors they mentioned closeness to the pupils and working preventive. Their offices were mentioned being both a restraining and promoting factor due to the central activity of dialogue. They expressed that they were all satisfied with their work, but that it would be enough to work full-time on just one school. To analyse the results the time-geographic perspective was used.</p>

The aim of this study was to examine how some Swedish school counsellor’s describe their school social work and how they look at its content. Further more the aim is to look at what restraining and promoting factors the school counsellor’s experience in their working situation. The approach of the study is qualitative and interviews have been made with five school counsellors. The results show that school counsellors have a variety of different working-areas, which consist of supporting and consulting pupils, parents and teachers through dialogue. Another assignment is to work preventive with groups and classes. Other scientists have found similar results as the ones in this study. About restraining and promoting factors in their work, the school counsellors expressed, for example, time and resources as restraining factors and as promoting factors they mentioned closeness to the pupils and working preventive. Their offices were mentioned being both a restraining and promoting factor due to the central activity of dialogue. They expressed that they were all satisfied with their work, but that it would be enough to work full-time on just one school. To analyse the results the time-geographic perspective was used.

Abstract Sweden has had a long tradition of freedom of the press and freedom of speech. Today the judicial area is regulated by the constitution of the press and the constitution of speech. The purpose of the two constitutions is to secure the right for every Swedish citizen to express their thoughts, opinions and feelings. The constitutions are designed to regulate the techniques with which the information is distributed and not to regulate the information in itself. This fact has caused a debate to arise on the subject whether the constitutions are still suitable to regulate the judicial area when the technical development causes the constitutions to get out of date and in need of constant updating. As a rule the usage of social media is not regulated by the constitution of speech the information distributed through these webpages can be included by the protection given by the constitution but very few of these webpages fulfill the criteria’s demanded by the constitution. The purpose of this essay is to ask the question whether the constitution of speech should be reformed to better regulate the technical development in the future. The essay examines whether a new constitution can be developed so that it no longer is tied to a certain technique and if it, in the future, should include all the information distributed through social media. It is the author´s conclusion that the constitution of freedom of speech should be concentrated on giving a special protection to professional companies’ whose occupation it is to distribute information to the public. This is the best way to preserve a regulation that is clear, consistent and easy to practice. A constitution that is given an area that is too wide to regulate will only restrain the freedom of speech and its founding principles and should therefore be avoided.

Syftet med denna kandidatuppsats var att utifrån professionellas perspektiv inom familjehemsvård förstå hur familjehemsplaceringar påverkar barns utveckling och vad som belyses vara viktigt i arbetet med familjehemsplaceringar av barn. Vad professionella anser vara viktigt i arbetet med, och erfarenhet av familjehemsplaceringars påverkan på barns utveckling, ger kunskap som förtydligar barns bästa i samhällsvård och är intressant att förtydliga i förhållande till svensk lagstiftning. Studien har en hermeneutisk utgångspunkt med en kvalitativ forskningsansats. Sex stycken semistrukturerade intervjuer genomfördes vilket bidrog till att en djupare förståelse kunde skapas. Studiens resultat visar att barn som familjehemsplaceras är en utsatt grupp och att en familjehemsplacering påverkar barns utveckling på olika sätt. Samt att arbetet med familjehemsplaceringar inkluderar flera viktiga aspekter och är omfattande enligt professionellas erfarenhet. Resultatet analyserades med hjälp av utvecklingsekologi. En slutsats är att barn som familjehemsplaceras även under placeringen påverkas av tidigare negativa erfarenheter, och att en familjehemsplacering kan kompensera för flera av de tidigare brister som barn haft, men inte för de svårigheter som placeringen medför.

Till akutmottagningen söker patienter i alla åldrar. Akutsjuksköterskan ska ha kunskap om och kunna omhänderta alla patienter som kommer till akutmottagningen. Pediatriska patienter har särskilda behov, deras fysiologi skiljer sig gentemot vuxna och de utgör därför en specifik patientgrupp. De kommunicerar och uttrycker sig inte heller som vuxna och kan redan i tidig ålder ge uttryck för smärta på sina egna sätt. Patientens aktiva deltagande varierar och patienten kan behöva olika former av stöd beroende på var i vårdprocessen de befinner sig. Det finns många faktorer som påverkar ett omhändertagande, både positivt och negativt. Syftet med studien var att belysa främjande och hindrande faktorer vid omhändertagande av barn på somatisk akutmottagning och utformades efter PEO (Population, Exposure, Outcome). Som metod användes en strukturerad litteraturöversikt med systematisk sökmetod. Resultatet av sökningarna i PubMed och Cinahl gav 15 artiklar med mixad ansats som analyserades med integrerad analysmetod. Det framkom sex huvudkategorier. Kommunikation och information med föräldrar som tar upp vikten av en öppen kommunikationsmiljö, informationsöverföring, sjuksköterskors centrala roll för kommunikation och att använda olika informationskällor för att underlätta kommunikationen. Under rubriken “kommunikation med barnet” framkom delaktighet i samtal om vårdprocessen, åldersanpassad kommunikation och information samt kommunikation om smärtupplevelser. Distraktion, smärtlindring, visad omtanke samt vårdmiljö var andra faktorer som visade sig påverka omhändertagandet av barn på somatisk akutmottagning. Slutsatsen från studien indikerar att omhändertagande av barn på somatisk akutmottagning kräver fokus på barnets delaktighet, familjecentrerad vård och kommunikation. Främjande faktorer kring omhändertagande är aktiv kommunikation, åldersanpassad och tillfredsställande information, distraktioner, snabb smärtlindring, anpassade vårdmiljöer samt visad omtanke. Hindrande faktorer är osäkerhet från närstående, lång väntan på smärtlindring och kommunikationssvårigheter. För ett effektivt och tillfredsställande omhändertagande av pediatriska patienter behöver hänsyn tas till de här främjande och hindrande faktorerna. / Patients of all ages come to the emergency department. The emergency specialist nurse must have knowledge of and be able to care for all patients who come to the emergency department. Pediatric patients have special needs, their physiology differs from that of adults and they therefore constitute a specific patient group. They do not communicate and express themselves like adults but can already at an early age express pain in their own ways. The patient's active participation varies and the patient may need different forms of support. There are many factors that affect emergency care, both positive and negative. The purpose of the study was to elucidate promoting and hindering factors in the care of children in somatic emergency departments and was designed according to PEO (population, exposure, outcome). The method used was a structured literature study with a systematic search. The result of the search in Pubmed and Cinahl yielded 15 articles with a mixed approach that were analyzed using an integrated analysis method. Six main categories emerged. Communication and information with parents that address the importance of an open communication environment, information transfer, nurse´s central role in communication and using different sources to facilitate communication. Under the heading "communication with the child", participation in conversations about the care process, age-appropriate communication and information and communication about pain experiences emerged. Distraction, pain relief, caring and care environment were other factors that were found to affect the care of children in somatic emergency departments. The conclusion from the study indicates that caring for acutely ill children requires a focus on the child's participation, family-centered nursing and communication. Promoting factors regarding emergency care are age-appropriate information, distractions, rapid pain relief, adapted care environments and shown consideration. Impeding factors are uncertainty from relatives, long waits for pain relief and communication difficulties. For good emergency care of pediatric patients these promoting and hindering factors need to be taken into account.

Syfte: Syftet med studien var att beskriva distriktssköterskors erfarenheter av vad som underlättade och hindrade evidensbaserad vård av ben- och fotsår inom primärvården. Metod: En kvalitativ intervjustudie med semistrukturerade intervjuer genomfördes med åtta distriktssköterskor. Samtliga arbetade på hälsocentraler i södra Hälsingland. Intervjuerna transkriberades och analyserades med kvalitativ innehållsanalys. Som teoretisk referensram användes PARIHS modellen. Huvudresultat: I studien framkom olika faktorer som underlättar respektive hindrar distriktssköterskor inom primärvården att arbeta efter en rutin för ben- och fotsår. Det som underlättade var ett välfungerande teamarbete på arbetsplatsen, att rutinen var anpassad så att den var lätt att arbeta efter och att den fanns lättillgänglig i datasystemet, specifik kunskap om sårvård och ett engagemang för patienten och för ämnet sårvård samt att patienten behöver stöd och utbildning för att kunna medverka i vården. Det som hindrade var bristande förståelse och engagemang från chef och kollegor, svårigheter att motivera patienterna till att medverka till behandling samt att journalsystemet inte var anpassat efter ben- och fotsårsrutinen. Slutsats: I studien framkom olika faktorer som underlättade och hindrade distriktssköterskor att använda sig av evidensbaserad vård av ben- och fotsår i det dagliga arbetet. Det som påverkade distriktssköterskornas användning av rutinen var i störst utsträckning faktorer i omgivningen. För att underlätta för distriktssköterskor att kunna arbeta enligt evidensbaserad sårvård måste ansträngningar göras för att undanröja hinder. PARIHS modellen kan användas som stödjande verktyg före, under och efter implementeringsprocessen. / Purpose: The purpose of the study was to describe district nurses' experiences of the facilitating and preventative factors that influence the use of evidence-based wound care in primary healthcare. Method : A qualitative interview study with semi-structured interviews was conducted with eight district nurses. All worked at health centers in southern Hälsingland. The interviews were transcribed and analyzed by qualitative content analysis. As a theoretical reference frame, the PARIHS model was used. Main outcome : The study revealed different factors that facilitate or prevent district nurses in primary healthcare to work for a routine for leg and foot ulcers. What facilitated was a well-functioning team work at the workplace, that the routine was adapted so that it was easy to work after and was easily accessible in the computer system, specific knowledge about wound care and commitment to the patient and on the subject of wound care and that the patient needs support and education to be able to participate in healthcare. What was prevented was insufficient understanding and commitment from the boss and colleagues, difficulty in motivating patients to participate in treatment and that the journal system was not adapted to the leg and foot routine. Conclusion : The study identified various factors which facilitated and prevented district nurses from using evidence-based care of leg and foot ulcers in their daily work. What influenced the use of the routine by district nurses was to the greatest extent factors in the environment. In order to facilitate district nurses to work according to evidence-based wound care, efforts must be made to eliminate obstacles. The PARIHS model can be used as a supporting tool before, during and after the implementation process.

Syftet med uppföljningsstudien var att undersöka deltagares upplevelser av verksamma/hindrande komponenter i behandlingen Hästunderstödd Kognitiv Beteendeterapi (HU-KBT) 12-18 månader efter avslutad behandling. Syftet var också att undersöka vad deltagarna upplever att de uppnått genom att delta i behandlingen HU-KBT. Semistrukturerade intervjuer genomfördes med fem deltagare. Intervjumaterialet analyserades med hjälp av kvalitativ tematisk analys. Ett flertal komponenter i behandlingen beskrevs som hjälpsamma; gruppen, terapeuten, hästen, miljön och olika specifika psykoterapeutiska komponenter. Hindrande behandlingskomponenter som framkom var negativa aspekter av att behandlas i grupp samt för lite tid. Effekter av behandlingen som beskrevs av deltagarna var förbättrad ångesthanteringsförmåga, förhöjd energinivå, förbättrad gränssättningsförmåga, minskat behov av att ha kontroll och ta ansvar för andra, ökad självinsikt, en ökad medvetenhet om och förståelse för känslor och hur dessa kan hanteras samt en förbättrad arbetsförmåga. Övrigt som framkom i intervjuerna var att förväntningarna var blandade, att det kunde finnas övriga livsomständigheter som kan ha påverkat utfallet av behandlingen, att effekten av behandlingen ofta var fördröjd, att behandlingen upplevdes som effektiv, att det förekom olika sätt som användes för att förhindra återfall samt att det fanns önskemål om att få ta del av ytterligare behandling och att behandlingen ska rikta sig till fler grupper av människor och även kunna erbjudas i förebyggande syfte. Resultaten ser lovande ut men det behövs ytterligare forskning för att vidare undersöka behandlingens effektivitet och verksamma komponenter. / The purpose of the follow-up study was to examine the participants' experiences of active/inhibitory components in the treatment Equine Assisted Cognitive Behavioral Therapy (HU-KBT) 12-18 months after treatment completion. The purpose was also to investigate the participant´s self-perceptions of achievement by participating in the HU-KBT treatment. Semi-structured interviews were conducted with five participants. The interview material was analyzed using qualitative thematic analysis. Several components of the treatment were described as helpful; the group, the therapist, the horse, the environment and several specific psychotherapeutic components. Obstructive treatment components that emerged were negative aspects of being treated in group and shortage of time. Effects of the treatment described by the participants were improved anxiety management, increased energy levels, improved ability to set boundaries, reductions in need to control others or to take responsibility for them, increased self-awareness, increased awareness and understanding of emotions and how they can be managed and an improved ability to work. Other things that emerged in the interviews were expectations were mixed; other life circumstances may have affected the outcome of the treatment; the effect of the treatment was often delayed; the treatment was perceived as effective; various ways were used to prevent relapse; there was a desire to gain access to further treatment and that the treatment should be aimed at more groups of people and also be offered for preventive purposes. The results look promising, but further research is needed to further investigate the efficacy and the operating components of the treatment.

Background: By the year 2030 the prognosis is that one fourth of the Swedish population will be 65 years or older. An age group that today stands for 40 percent of all the daily visits in the Swedish emergency departments. Nearly half of them are 80 years or older. The frail older adults are often low prioritized due to their diffuse symptoms whereby long waiting times and healthcare-related injuries may occur. As a complement to the standard prioritizing procedure, that triage stands for, some emergency departments have introduced screening tools for detecting those individuals that are older adults and frail. Unfortunately, the introduction of new guidelines, do not always imply that the implementation comes easy because there are factors that facilitate and inhibit their intended use. Aim: To illustrate factors that affect the nurses use of the screening tool Clinical Frailty Scale (CFS) which identifies frailty in elders during triage in the emergency department. Method: A descriptive quantitative cross-sectional study where data was collected through a web-based questionnaire. The data of the study was analyzed through descriptive and analytical statistics. Results: When it came to influencing factors regarding the use of CFS in the selected emergency department, CFS as a method with its practicalities constituted as facilitators, whilst the organizational and working cultural aspects constituted as barriers. The differences in the nurses' experience and education effected the perception of CFS in different ways. Conclusion: There is a need of a working culture where responsibility is shared between stakeholders to facilitate a guideline. Advanced nurse practitioners can have a crucial role in educating, motivating and creating space for discussion relating to organizational, theoretical and practical components of the process in identifying the frail older adults. / Bakgrund: Prognosen är att år 2030 kommer en fjärdedel av den svenska populationen vara 65 år eller äldre. Åldersgruppen utgör idag cirka 40 procent av alla besök på Sveriges akutmottagningar där nästan hälften av dem är 80 år eller äldre. De sköra äldre erhåller ofta låg prioritering på grund av sina diffusa symtom, där långa väntetider och vårdrelaterade skador kan uppstå som följd. Som komplement i den vanliga prioriteringsrutinen som triagering innebär har akutmottagningar infört screeningverktyg för att upptäcka de individer som är sköra äldre. Dessvärre innebär införandet av nya rutiner att de inte alltid lätt implementeras i verksamheten eftersom det finns faktorer som främjar och hindrar dess avsedda användning. Syfte: Att belysa faktorer som påverkar sjuksköterskors användning av screeningverktyget Clinical Frailty Scale (CFS) för att identifiera sköra äldre vid triagering på akutmottagningen. Metod: En kvantitativ tvärsnittsstudie där data samlades in genom en webbenkät. Studiens data analyserades deskriptivt samt med analytisk statistisk. Resultat: När det kom till faktorer som påverkade användningen av CFS på den valda akutmottagningen utgjorde CFS som metod med dess praktiska delar en främjande faktor, medan organisatoriska och arbetskulturella aspekter utgjorde hindrande faktorer. Skillnaderna i erfarenhet och utbildning hos sjuksköterskorna påverkade uppfattningen om CFS på olika sätt. Slutsats: Det behövs en arbetskultur med ett delat ansvar mellan organisation och medarbetare för att främja följsamheten till en rutin. Specialistsjuksköterskor kan ha en betydande roll i att utbilda, motivera och skapa forum för diskussion gällande organisatoriska, teoretiska och praktiska delar i processen av att identifiera sköra äldre.

Additive manufacturing (AM) has enabled the possibility for the hospitals to become their own implant producers developing implants that are tailored to patient’s anatomy. Despite the enormous potential of custom-made implants there are challenges that complicate the implementation of them into clinical practice. The aim of this research is to (1) identify the main driving forces and barriers for the delivery of custom-made implants; (2) explore staff stakeholder views and practices related to the implementation of AM in surgery for the development of custom-made implants; (3) formulate recommendations on how to cope with the implementation challenges. The research method was an explorative qualitative study consisted of a literature review on the challenges of custom-made implants in clinical applications coupled with the collection and inductive analysis of empirical data. The empirical study was based on ten semi-structured interviews conducted among both domestic and international hospital managers medical doctors and research engineers. The consolidated framework for implementation research (CFIR) was utilized for data collection. Using the five domains of CFIR, the following results were obtained: (1) Characteristics of individuals: Most research participants indicated a positive attitude towards the innovation expressing self-efficacy to its use; (2) Intervention characteristics: Custom-made implants were perceived to have a relative advantage in surgical practice due to their high degree of observability and geometrical adaptability providing increased surgical quality, perfect patient fit and better understanding of pathologies. However, high implementation costs, low degree of trialability and high degree of complexity in the development process were regarded as drawbacks of the innovation; (3) Outer setting: the regulatory uncertainty and lack of reimbursement limit the accessibility of custom-made implants to low income populations; (4) Inner setting: scarcity of resources, staff resistance to change, insufficient management support, communication difficulties, limited access to educational materials and training opportunities as well as lack of time and innovative capacity were regarded by the majority of participants as implementation barriers; (5) Process: central for the success of implementation is the need for a coherent implementation plan and evaluation process as well as the engagement of key stakeholders such as hospital managers, payers, regulatory and implementation advisors. This dissertation proffers a deeper understanding of the implementation issues related to custom-made implants and offers preliminary recommendations on how to cope with implementation impediments through the use of Rogers diffusion of innovation coupled with concepts from the field of organizational change and innovation management including Clayton’s disruptive innovation.